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Systemic Toxicity From Topically Applied Lidocaine in Conjunction With Fractional Photothermolysis

2006; American Medical Association; Volume: 142; Issue: 8 Linguagem: Inglês

10.1001/archderm.142.8.1024

1538-3652

Diego E. Marra, Darwin Yip, Edgar F. Fincher, Ronald L. Moy,

Advancements in Transdermal Drug Delivery

Background: Topical anesthetics, unlike injectable anesthetics, can be applied painlessly and can provide sufficient pain control to maintain patient comfort throughout a variety of laser procedures.Although the use of topical lidocaine is considered relatively safe, instances of cardiotoxic and neurotoxic adverse events have been reported to occur.Observations: A 52-year-old woman underwent fractional photothermolysis for management of severe hypopigmentation and scarring of several years' duration.Shortly after termination of treatment to her face and neck, which required prolonged exposure to a 30% lidocaine gel compound both before and during surgery, she developed clinical signs and symptoms consistent with systemic lidocaine toxicity.The results of laboratory studies confirmed serum lidocaine levels within the toxic range.We postulate that the combination of the high con-centration of topical lidocaine required to achieve sufficient anesthesia, together with the laser-induced disruption in epidermal barrier function, may have been responsible for this phenomenon.